Current state of transanal minimally invasive surgery in the management of rectal cancer
|
|
- Wilfrid Goodman
- 5 years ago
- Views:
Transcription
1 Erkan et al. Mini-invasive Surg 2018;2:30 DOI: / Mini-invasive Surgery Review Open Access Current state of transanal minimally invasive surgery in the management of rectal cancer Arman Erkan, Justin J. Kelly, John R. T. Monson Center for Colon & Rectal Surgery, AdventHealth, Orlando, FL 32804, USA. Correspondence to: Dr. John R.T. Monson, Center for Colon & Rectal Surgery, AdventHealth, Orlando, FL 32804, USA. How to cite this article: Erkan A, Kelly JJ, Monson JRT. Current state of transanal minimally invasive surgery in the management of rectal cancer. Mini-invasive Surg 2018;2:30. Received: 11 Jul 2018 First Decision: 23 Aug 2018 Revised: 3 Sep 2018 Accepted: 4 Sep 2018 Published: 26 Sep 2018 Science Editor: Gordon N. Buchanan Copy Editor: Cui Yu Production Editor: Huan-Liang Wu Abstract Rectal cancer surgery has undergone a rapid change over the last few decades. We have come a long way from abdominoperineal resection to minimally invasive sphincter preserving techniques. Colorectal cancer screening programs made it possible to diagnose patients at earlier stages and this has led to question the necessity of radical surgery and the possibility of organ preservation. The platform most recently added to the surgical armamentarium is transanal minimally invasive surgery (TAMIS). It utilizes conventional laparoscopic tools to perform endoluminal surgery in rectum. Along with the conceptual changes in rectal cancer management, TAMIS is more frequently used for local excision of malignant rectal tumors. This review highlights the recent advances and current state of the role of TAMIS in the management of rectal cancer at various stages. Keywords: Rectal cancer, transanal minimally invasive surgery, local excision INTRODUCTION The ultimate aim of rectal cancer treatment is to provide safe oncological cure while maintaining enteral continuity and preserving sphincter function. In many cases, it is challenging to achieve excellent results in all three components [1]. The multimodal treatment of rectal cancer is following a similar path to breast cancer: less invasive surgical techniques are being utilized to preserve anatomical and functional integrity without compromising oncological outcomes. It has undergone a seismic change from abdominoperineal resection to low anterior resection, local excision and finally watch-and-wait approach, following neoadjuvant treatment in select The Author(s) Open Access This article is licensed under a Creative Commons Attribution 4.0 International License ( which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
2 Page 2 of 10 Erkan et al. Mini-invasive Surg 2018;2:30 I patients. This change was manifest in tandem to the technical advancements like the introduction of circular staplers, surgical refinements - popularization of strict adherence to anatomical planes by Heald, and of course recognition of the importance of neoadjuvant chemotherapy and radiotherapy [2]. Not only has the nomenclature around the operation changed, but so too has the platform to access the rectum. The introduction of laparoscopy has revolutionised colorectal surgical practice and continues to evolve. Robotic surgery platforms have also garnered some popularity, in particular, for access to the lower third of the rectum. Since 2010, the introduction of minimally invasive approaches has been applied to the rectum via a transanal approach [3], and has been utilised in a broad spectrum of clinical scenarios; from transanal polyp excision to anastomotic leak repair, local excision of rectal cancer, transanal total mesorectal excision (tatme) and pelvic exenteration [4-9]. The advent of widespread colorectal cancer screening has made it possible to diagnose rectal polyps and early stage rectal cancers more frequently. This increasing trend along with increasing response rates to more effective neoadjuvant treatment for locally advanced rectal cancers and patient demands for organsparing options has led leaders in the field to push the boundaries of surgical approaches to the rectum and to reappraise the paradigm of formal proctectomy. Moreover, patients who require local palliation in the setting of stage IV disease and the aging population with medical comorbidities who would be otherwise unfit for any abdominal approach, constitute another group of patients for whom local interventions per anus may prove to be more beneficial overall. The aim of this study is to review the current state of the role of transanal minimally invasive surgery (TAMIS) in the local management of rectal cancer and highlight the recent advances, with an emphasis on functional results and complications. LOCAL EXCISION The term local excision refers to removal of the tumor with negative surgical margins without removing the organ it originates from - the rectum. It involves full thickness resection of the rectal wall but not necessarily the draining lymphatics. Enthusiasm about local excision for early stage rectal cancer has grown after Morson et al. [10] published their results in This has led to development of techniques other than transanal excision (TAE), which is limited by poor exposure and limited to lesions in the distal rectum. Currently, the two most popular options for local excision are transanal endoscopic microsurgery (TEM) and TAMIS. TAE utilizes conventional instruments under direct vision. It cannot reach mid- or upper rectal lesions. Moreover, confinement of the operative field risks the achievement of negative surgical margins. Margin positivity exceeds 10% even in experienced hands [11,12]. In a recent study, TAE is not considered as a feasible technique for tumors located higher than the first rectal valve, > 3 cm in size and deeper than T1 [13]. TEM, first described in 1984 by Buess et al. [14] utilized a rigid platform to access intraluminal lesions in the rectum. It has several advantages over TAE. It maintains a stable pneumorectum and makes it possible to reach the mid and upper rectum. Improved visualization results in better assessment of resection margins. When compared to conventional TAE, TEM provides a superior quality resection, with higher rates of negative microscopic margins, reduced rates of specimen fragmentation and lesion recurrence, but with equivalent post-operative complications [15]. However, several factors have limited the widespread uptake within the armamentarium of colorectal surgeons throughout the world. These include a steep learning curve, significant cost of the operating system and concerns about postoperative function [16].
3 Erkan et al. Mini-invasive Surg 2018;2:30 I Page 3 of 10 The need for an oncologically safe and also cost effective procedure led to evolution of TAMIS. TAMIS utilizes conventional laparoscopic devices and a single incision port rather than a specialized platform. Therefore, it lowers the cost of the procedure, while giving the surgeon an opportunity to operate with familiar instruments. It also allows for a 360 exposure of the rectal lumen, which is another superiority over TEM. While TEM requires repositioning of the patient or the platform, TAMIS allows operating in multiple quadrants using the same configuration. First described in 2010, TAMIS was found to be a feasible alternative to TEM, providing its benefits at a fraction of the cost without specialized instrumentation [1,3,17-19]. AN INDIVIDUALIZED APPROACH FOR PATIENTS Patients with rectal cancer being considered for local excision, should undergo routine staging workup like any other rectal cancer patient, including dedicated magnetic resonance imaging of rectum for local staging, computed tomography of chest, abdomen and pelvis to screen for distant metastases and baseline carcinoembryonic antigen level to guide future follow-up and treatment. Neoadjuvant treatment followed by TME is still considered the gold standard treatment for locally invasive rectal cancer in terms of oncological outcomes. However, it also has significant effects on patients quality of life. The Dutch Colorectal Cancer Group reported 14% fecal incontinence, 52% bowel dysfunction and 57% urinary incontinence at 5-year follow-up [20]. These relatively high morbidity rates have strengthened the search for alternative treatment options providing a balance of favourable functional outcomes without compromising oncological results. The uptake of colorectal cancer screening has enabled more patients to be diagnosed at an early stage [2]. We have also more knowledge about tumor biology and risk factors for aggressive behaviour of the disease. All of these together, bring up the potential for less radical organ preserving surgery in an effort to improve patients quality of life. One concern for local excision is excessive tissue removal leading to a narrowed lumen and rectal stenosis. However, we know from TEM literature that stenosis following TEM excision is rare unless the lesion is circumferential. Recently, McLemore et al. [21] reported a single case of rectal stenosis in a cohort of 32 patients who underwent TAMIS for both benign and malignant rectal tumors. The patient who developed stenosis had a large circumferential adenoma and was subsequently managed successfully with endoscopic dilation. T1N0 Early rectal cancer is defined as cancer confined to submucosa [22]. Kikuchi et al. [23] further classified early rectal cancer according to depth of invasion of the tumor by dividing submucosal layer into thirds. While the risk of lymph node metastasis is 3% for lesions invading the superficial 1/3 of submucosa (SM1), it rises up to 8% for middle (SM2) and to 23% for deeply invading lesions (SM3) [24-26]. The 2013 American Society of Colon and Rectal Surgeons practice parameters for the management of rectal cancer state that local excision is an appropriate treatment modality for carefully selected T1 rectal cancers without high-risk features [27]. Favourable T1 lesions have a less than 10% risk of lymph node metastasis and local excision can be potentially curable for these patients [2] [Figures 1-3]. The Swedish Rectal Cancer Registry analysis demonstrated that the rate of lymph node metastasis is 6% in the absence of adverse features (lymphovascular invasion or poor differentiation). A recent analysis of Surveillance, Epidemiology, and End Results database, showed that local excision of T1 rectal cancer does not affect cancer-specific survival when compared to radical surgery. However, less radical approach comes at a cost of need for more frequent and careful follow-ups [28].
4 Page 4 of 10 Erkan et al. Mini-invasive Surg 2018;2:30 I A B C Figure 1. A T1 SM1 tumor excised by transanal minimally invasive surgery. A: Marking of resection margins with electrocautery; B: completed full thickness excision; C: closure of rectal wall defect A B C Figure 2. A near-obstructing T1 malignant polyp with a thin stalk excised by transanal minimally invasive surgery. A: Large tumor in mid rectum; B: rectal wall defect not closed after excision; C: the specimen after excision Due to the fact that TAMIS is a novel technique, oncological outcome data after TAMIS for rectal cancer is limited thus far simply by length of follow-up. In a comparative study by Lee et al. [29], margin positivity was 7% and lesion fragmentation was 4% for TAMIS, which was not significantly different from TEM. Local recurrence was 6% after high quality excision compared with 13% after poor quality excision. Another study comprising 110 rectal cancer patients, a positive margin was seen in 8% and tumor fragmentation in 5% of patients. For patients who did not undergo immediate salvage radical surgery, local recurrence rate was 6%, and distant metastasis rate was 2% after a median follow-up 14.4 months [30]. Martin-Perez et al. [31] performed a systemic review of 16 high quality case series, they reported an overall margin positivity of 4.4% and tumor fragmentation was 4.1%. On the other hand, another meta-analysis of 4510 patients highlighted the risk factors for lymph node metastasis for T1 lesions as submucosal invasion > 1 mm, lymphovascular invasion, poor differentiation and tumor budding [32]. If any of these risk factors are present on final pathology, total mesorectal excision is recommended in medically fit patients due to the high risk of lymph node metastasis. Similarly, for rectal neuroendocrine tumors > 20 mm or with adverse features, radical surgery is warranted in suitable patients [1,15]. Data from TEM literature suggest a reduction in mesorectal excision quality in patients who undergo salvage radical resection after local recurrence following local excision [33]. Lower quality mesorectal excision leads to higher local recurrence and a reduction in survival, which therefore emphasizes the importance of patient selection for local excision in the first place. Local excision following neoadjuvant therapy With increasing interest in watch-and-wait approach for complete clinical response following neoadjuvant chemoradiation, there has also been a trend towards local excision to evaluate and confirm mural pathologic response. Additionally, local excision is being utilized more commonly for patients whose tumors
5 Erkan et al. Mini-invasive Surg 2018;2:30 I Page 5 of 10 Figure 3. A T1 tumor excised with clear margins fixed on the board after transanal minimally invasive surgery excision have been clinically downstaged but not responded completely. However it should be kept in mind that even with a complete pathologic response of primary tumor (ypt0), the risk of nodal positivity remains 3%-6% [34-36]. In 2016, Shin et al. [37] published retrospective data of 34 patients who had local excision following neoadjuvant chemoradiation. They included patients with only complete or near complete clinical response. A pathologic complete response was achieved in 56% of patients, 35% had T1 and 9% had T2 tumor in their final pathology. Only 2 patients developed recurrence (one local recurrence and one distant metastasis) during a 5-year follow-up period. In this study, all lesions were located in low rectum; 28 patients had TAE and 6 patients had TAMIS. Lee et al. [30] published a wider range of patients with more advanced stage. They investigated the role of TAMIS for patients with T2/T3 N+ disease who received neoadjuvant chemoradiation and responded clinically with negative lymph nodes on post treatment imaging and a final tumor showing a small whitish scar and/or shallow ulcer on sigmoidoscopy. On final pathology, 18 patients showed a pathologic complete clinical response of primary tumor, whereas 11 patients still had T2/T3 tumor. All of these patients refused to undergo further surgery and nearly half of them (5 of 11 patients) developed local and/or distant recurrence during the median follow-up of 36 months. Local excision for more advanced tumors As of today, the gold standard treatment of T2-T4 lesions is TME due to high risk of lymph node metastasis. Local excision of T2-T4 lesions can be considered as an oncologically inferior but less invasive alternative to radical excision in several clinical scenarios; including patients with multiple comorbidities who are medically unfit to undergo a major abdominopelvic procedure or patients with metastatic disease but who need local control for palliation [Figure 4]. There may also be some patients who demonstrate understand-
6 Page 6 of 10 Erkan et al. Mini-invasive Surg 2018;2:30 I Figure 4. An obstructing T3 tumor excised by transanal minimally invasive surgery for palliation in a patient with liver and lung metastases ing and refuse radical resection to avoid its complications like fecal or sexual dysfunction, or to maintain intestinal continuity and avoid a permanent colostomy with an acceptable risk of higher recurrence rate. Knowledge about the role of local excision for lesions deeper than T1 is mostly limited to small series of patients who declined TME or were unfit for abdominal surgery [19] [Figure 5]. These series have reported significantly higher local recurrence rates. These series also do not follow a standard protocol of chemotherapy or radiotherapy. Lezoche et al. [38] studied the long-term outcomes of 70 patients with T2N0 rectal cancer randomized to TEM or laparoscopic TME. All patients in each group had received neoadjuvant chemoradiation. They reported a local recurrence rate of 5.7% after local excision versus 2.8% percent after laparoscopic TME, with a median follow-up of 84 months. There was no difference in disease-free survival. Similarly, American College of Surgeons Oncology Group (ACOSOG) Z6041 trial investigated the role of local excision for clinically staged T2N0 rectal cancer following neoadjuvant chemoradiation. Local recurrence rate was reported as 4% and distant metastasis as 6% after a median follow-up of 56 months [39]. FUNCTIONAL OUTCOMES AND QUALITY OF LIFE The biggest driving force behind less invasive approaches for rectal cancer - especially for early rectal cancer - is the high morbidity of gold standard technique; TME. Functionally unfavourable outcomes in intestinal, urinary and sexual functions are the major concerns for patients postoperative quality of life (QoL). Local excision can potentially decrease the incidence of these complications and improve QoL. TEM has been associated with fecal incontinence due to its 4-cm diameter scope and rates of up to 37% worse incontinence has been reported after TEM [40]. TAMIS seems more advantageous in this regard as it utilizes a flexible port to access rectum. Although longer term follow-up data is available for TEM, the impact of TAMIS on patients QoL is unclear - due to it being a relatively new technique. Recently, Clermonts et al. [41] published their data of 37 patients who underwent TAMIS for dysplastic sessile polyps or ct1 rectal cancer. They compared Short-Form 36 Health Survey responses of 37 patients to a healthy case-matched population. This study demonstrated that patients scored worse than healthy control group in physical functioning, general health perception and social functioning domains. After a 3-year follow-up, 9 patients reported improved fecal incontinence severity index (FISI) scores, 19 patients deteriorated and 9 patients remained same. On the other hand, Verseveld et al. [42] compared QoL of 24 patients undergoing TAMIS before and 6
7 Erkan et al. Mini-invasive Surg 2018;2:30 I Page 7 of 10 Figure 5. A T2 rectal tumor specimen fixed on board after transanal minimally invasive surgery excision months after the surgery. They did not note any deterioration, but a general improvement in QoL and more specifically in FISI scores after TAMIS. Schiphorst et al. [43] similarly reported FISI scores of 35 patients pre- and post-tamis. Their data showed that 3 of 18 patients with normal continence developed soiling after the surgery but 2 of them returned to normal in 6 months. Fifteen of 17 patients with abnormal FISI score showed improvement in fecal continence following TAMIS. These studies yield varying results. It should be kept in mind that one of these studies compared TAMIS patients to healthy control group, and the other two compared the same patients pre- and post-operative status. A study comparing functional outcomes and QoL of patients who underwent TAMIS versus TME would give a more meaningful picture in terms of the functional benefits of local excision over radical resection. COMPLICATIONS Lee et al. [29] reported postoperative morbidity of TAMIS to be 9% in a series of 228 patients comprising both benign and malignant tumors. In another study by the same group, complication rates of TAMIS in a group of 110 rectal cancer patients was 15%. The most common complications of TAMIS were urinary retention, perioperative bleeding and peritoneal violation; similar to TAE and TEM [30]. Both urinary retention and peritoneal entry have been associated with anterior and lateral location of the tumor. Urinary retention is usually self-limited and treated by temporary urinary catheterization. Entry into peritoneal cavity has been reported more frequently with upper lesion location (> 8-10 cm from anal verge). The largest TAMIS series published to date had an incidence of peritoneal entry of only 2%. In contrast, the incidence is reported as 6%-8.6% for TEM. Either transanal or laparoscopic suturing can be utilized when a peritoneal defect occurs. It is not associated with increased morbidity. Risk is further reduced in the setting of preoperative bowel preparation and intravenous antibiotic treatment for 24 h postoperatively [18,19,44]. In these patients, a gastrograffin enema is recommended on postoperative day 3 to document the absence of a leak [2]. Mean blood loss for local excision of rectal cancer is 28 ml [30]. Increased bleeding has been associated with large tumor size. Cases of post-procedural hemorrhage that do not stop spontaneously have in all cases been managed successfully either endoscopically or with examination under anesthesia and sewing [1]. Less commonly reported complications include urinary tract infection, subcutaneous emphysema, scrotal
8 Page 8 of 10 Erkan et al. Mini-invasive Surg 2018;2:30 I edema and hemorrhoidal thrombosis [2]. Barendse et al. [45] concluded that a learning curve effect was observed in complication rates. However, a specific case volume was not defined in this study and complication rates before and after the learning curve were not compared. Lee et al. [46] investigated the learning curve in a single high volume tertiary care referral center and found that the learning curve of TAMIS for rectal neoplasms is cases. This study did not show a difference in complication rates before and after the learning curve. CONCLUSION Based on currently available clinical data, TAMIS in experienced hands, results in the high quality local excision of early rectal tumors with low histological margin positivity in an efficient manner and low recurrence rates in context of favourable histologic properties with an excellent morbidity profile with no long term adverse effect on continence. The role of TAMIS for more advanced tumors and in the post-neoadjuvant setting needs clarification by further studies. It can also be offered as a palliative procedure to patients with metastatic disease, which would potentially avoid complications of a major surgery. TAMIS has enabled the performance of high quality local excision of rectal lesions by many colorectal surgeons, integrating transanal endoscopic surgery into mainstream practice. Currently surgeon preference and device availability govern which platform is selected for use. As with all new techniques used in the management of neoplastic disease, appropriate training must be ensured and the continued assessment and assurance of oncological outcome - via databases - must be maintained. DECLARATIONS Authors contributions Design, literature research, manuscript writing, manuscript editing, manuscript revision: Erkan A, Kelly JJ, Monson JRT Availability of data and materials Not applicable. Financial support and sponsorship None. Conflicts of interest All authors declared that there are no conflicts of interest. Ethical approval and consent to participate Not applicable. Consent for publication Not applicable. Copyright The Author(s) REFERENCES 1. Young DO, Kumar AS. Local excision of rectal cancer. Surg Clin North Am 2017;97: Plummer JM, Leake PA, Albert MR. Recent advances in the management of rectal cancer: no surgery, minimal surgery or minimally invasive surgery. World J Gastrointest Surg 2017;9: Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 2010;24:
9 Erkan et al. Mini-invasive Surg 2018;2:30 I Page 9 of Atallah SB, Larach S, debeche-adams TC, Albert MR. Transanal minimally invasive surgery (TAMIS): a technique that can be used for retrograde proctectomy. Dis Colon Rectum 2013;56: Brunner W, Rossetti A, Vines LC, Kalak N, Bischofberger SA. Anastomotic leakage after laparoscopic single-port sigmoid resection: combined transanal and transabdominal minimal invasive management. Surg Endosc 2015;29: Caycedo-Marulanda A, Jiang HY, Kohtakangas EL. Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique. Can J Surg 2017;60: debeche-adams T, Nassif G. Transanal minimally invasive surgery. Clin Colon Rectal Surg 2015;28: Hayashi K, Kotake M, Kakiuchi D, Yamada S, Hada M, Kato Y, Hiranuma C, Oyama K, Hara T. Laparoscopic total pelvic exenteration using transanal minimal invasive surgery technique with en bloc bilateral lymph node dissection for advanced rectal cancer. Surg Case Rep 2016;2: Quaresima S, Balla A, Franceschilli L, La Torre M, Iafrate C, Shalaby M, Di Lorenzo N, Sileri P. Transanal minimally invasive surgery for rectal lesions. JSLS 2016; doi: /JSLS Morson BC, Bussey HJ, Samoorian S. Policy of local excision for early cancer of the colorectum. Gut 1977;18: Garcia-Aguilar J, Mellgren A, Sirivongs P, Buie D, Madoff RD, Rothenberger DA. Local excision of rectal cancer without adjuvant therapy: a word of caution. Ann Surg 2000;231: Paty PB, Nash GM, Baron P, Zakowski M, Minsky BD, Blumberg D, Nathanson DR, Guillem JG, Enker WE, Cohen AM, Wong WD. Long-term results of local excision for rectal cancer. Ann Surg 2002;236: Salehomoum NM, Nogueras JJ. Conventional transanal excision: current status and role in the era of transanal endoscopic surgery. Semin Colon Rectal Surg 2015;26: Buess G, Hutterer F, Theiss J, Böbel M, Isselhard W, Pichlmaier H. A system for a transanal endoscopic rectum operation. Chirurg 1984;55: Rai V, Mishra N. Transanal approach to rectal polyps and cancer. Clin Colon Rectal Surg 2016;29: Maglio R, Muzi GM, Massimo MM, Masoni L. Transanal minimally invasive surgery (TAMIS): new treatment for early rectal cancer and large rectal polyps-experience of an Italian center. Am Surg 2015;81: Althumairi AA, Gearhart SL. Local excision for early rectal cancer: transanal endoscopic microsurgery and beyond. J Gastrointest Oncol 2015;6: Melin AA, Kalaskar S, Taylor L, Thompson JS, Ternent C, Langenfeld SJ. Transanal endoscopic microsurgery and transanal minimally invasive surgery: is one technique superior? Am J Surg 2016;212: Thompson EV, Bleier JI. Transanal minimally invasive surgery. Clin Colon Rectal Surg 2017;30: Peeters KC, van de Velde CJ, Leer JW, Martijn H, Junggeburt JM, Kranenbarg EK, Steup WH, Wiggers T, Rutten HJ, Marijnen CA. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients--a Dutch colorectal cancer group study. J Clin Oncol 2005;23: McLemore EC, Weston LA, Coker AM, Jacobsen GR, Talamini MA, Horgan S, Ramamoorthy SL. Transanal minimally invasive surgery for benign and malignant rectal neoplasia. Am J Surg 2014;208: Loughrey MB, Quirke P, Shepherd NA. Standards and datasets for reporting cancers. 4th ed. London: the Royal College of Pathologists; Kikuchi R, Takano M, Takagi K, Fujimoto N, Nozaki R, Fujiyoshi T, Uchida Y. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum 1995;38: Kitajima K, Fujimori T, Fujii S, Takeda J, Ohkura Y, Kawamata H, Kumamoto T, Ishiguro S, Kato Y, Shimoda T, Iwashita A, Ajioka Y, Watanabe H, Watanabe T, Muto T, Nagasako K. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol 2004;39: Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 1993;25: Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 2002;45: Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD, Rafferty J; Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum 2013;56: Brunner W, Widmann B, Marti L, Tarantino I, Schmied BM, Warschkow R. Predictors for regional lymph node metastasis in T1 rectal cancer: a population-based SEER analysis. Surg Endosc 2016;30: Lee L, Edwards K, Hunter IA, Hartley JE, Atallah SB, Albert MR, Hill J, Monson JR. Quality of local excision for rectal neoplasms using transanal endoscopic microsurgery versus transanal minimally invasive surgery: a multi-institutional matched analysis. Dis Colon Rectum 2017;60: Lee L, Burke JP, debeche-adams T, Nassif G, Martin-Perez B, Monson JRT, Albert MR, Atallah SB. Transanal minimally invasive surgery for local excision of benign and malignant rectal neoplasia: outcomes from 200 consecutive cases with midterm follow up. Ann Surg 2018;267: Martin-Perez B, Andrade-Ribeiro GD, Hunter L, Atallah S. A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to Tech Coloproctol 2014;18: Beaton C, Twine CP, Williams GL, Radcliffe AG. Systematic review and meta-analysis of histopathological factors influencing the risk of lymph node metastasis in early colorectal cancer. Colorectal Dis 2013;15: Saclarides TJ. Transanal endoscopic microsurgery. Clin Colon Rectal Surg 2015;28: Bedrosian I, Rodriguez-Bigas MA, Feig B, Hunt KK, Ellis L, Curley SA, Vauthey JN, Delclos M, Crane C, Janjan N, Skibber JM. Predicting the node-negative mesorectum after preoperative chemoradiation for locally advanced rectal carcinoma. J Gastrointest Surg 2004;8: Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Kepka L, Winkler-Spytkowska B, Suwiński R, Oledzki J, Stryczyńska G, Wieczorek
10 Page 10 of 10 Erkan et al. Mini-invasive Surg 2018;2:30 I A, Serkies K, Rogowska D, Tokar P; Polish Colorectal Study Group. Prediction of mesorectal nodal metastases after chemoradiation for rectal cancer: results of a randomised trial: implication for subsequent local excision. Radiother Oncol 2005;76: Yeo SG, Kim DY, Kim TH, Chang HJ, Oh JH, Park W, Choi DH, Nam H, Kim JS, Cho MJ, Kim JH, Park JH, Kang MK, Koom WS, Kim JS, Nam TK, Chie EK, Kim JS, Lee KJ. Pathologic complete response of primary tumor following preoperative chemoradiotherapy for locally advanced rectal cancer: long-term outcomes and prognostic significance of pathologic nodal status (KROG 09-01). Ann Surg 2010;252: Shin YS, Yoon YS, Lim SB, Yu CS, Kim TW, Chang HM, Park JH, Ahn SD, Lee SW, Choi EK, Kim JC, Kim JH. Preoperative chemoradiotherapy followed by local excision in clinical T2N0 rectal cancer. Radiat Oncol J 2016;34: Lezoche E, Guerrieri M, Paganini AM, Feliciotti F. Long-term results of patients with pt2 rectal cancer treated with radiotherapy and transanal endoscopic microsurgical excision. World J Surg 2002;26: Garcia-Aguilar J, Renfro LA, Chow OS, Shi Q, Carrero XW, Lynn PB, Thomas CR Jr, Chan E, Cataldo PA, Marcet JE, Medich DS, Johnson CS, Oommen SC, Wolff BG, Pigazzi A, McNevin SM, Pons RK, Bleday R. Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol 2015;16: Dafnis G, Påhlman L, Raab Y, Gustafsson UM, Graf W. Transanal endoscopic microsurgery: clinical and functional results. Colorectal Dis 2004;6: Clermonts SHEM, van Loon YT, Wasowicz DK, Langenhoff BS, Zimmerman DDE. Comparative quality of life in patients following transanal minimally invasive surgery and healthy control subjects. J Gastrointest Surg 2018;22: Verseveld M, Barendse RM, Gosselink MP, Verhoef C, de Graaf EJ, Doornebosch PG. Transanal minimally invasive surgery: impact on quality of life and functional outcome. Surg Endosc 2016;30: Schiphorst AH, Langenhoff BS, Maring J, Pronk A, Zimmerman DD. Transanal minimally invasive surgery: initial experience and short-term functional results. Dis Colon Rectum 2014;57: Keller DS, Haas EM. Transanal minimally invasive surgery: state of the art. J Gastrointest Surg 2016;20: Barendse RM, Dijkgraaf MG, Rolf UR, Bijnen AB, Consten EC, Hoff C, Dekker E, Fockens P, Bemelman WA, de Graaf EJ. Colorectal surgeons learning curve of transanal endoscopic microsurgery. Surg Endosc 2013;27: Lee L, Kelly J, Nassif GJ, Keller D, Debeche-Adams TC, Mancuso PA, Monson JR, Albert MR, Atallah SB. Establishing the learning curve of transanal minimally invasive surgery for local excision of rectal neoplasms. Surg Endosc 2018;32:
Early Rectal Cancer Surgical options Organ Preservation? Chinna Reddy Colorectal Surgeon Western General, Edinburgh
Early Rectal Cancer Surgical options Organ Preservation? Chinna Reddy Colorectal Surgeon Western General, Edinburgh What is Early rectal cancer? pt1t2n0m0 Predictors for LN involvement Size Depth Intramural
More informationTransanal minimally invasive surgery (TAMIS): validating short and long-term benefits for excision of benign and early stage rectal cancers
Editorial Page 1 of 5 Transanal minimally invasive surgery (TAMIS): validating short and long-term benefits for excision of benign and early stage rectal cancers Anthony P. D Andrea, Erin Duggan, Patricia
More informationTransanal endoscopic microsurgery for early rectal cancer: single center experience
Original paper Videosurgery Transanal endoscopic microsurgery for early rectal cancer: single center experience Narimantas Samalavicius 1,2, Marijus Ambrazevicius 1, Alfredas Kilius 1, Kestutis Petrulis
More informationState-of-the-art of surgery for resectable primary tumors
Early colorectal cancer State-of-the-art of surgery for resectable primary tumors (Special focus on rectal cancer surgery) Stefan Heinrich & Hauke Lang Department of General, Visceral and University Hospital
More informationCHAPTER 7 Concluding remarks and implications for further research
CONCLUDING REMARKS AND IMPLICATIONS FOR FURTHER RESEARCH CHAPTER 7 Concluding remarks and implications for further research 111 CHAPTER 7 Molecular staging of large sessile rectal tumors In this thesis,
More informationOriginal Policy Date
MP 7.01.92 Transanal Endoscopic Microsurgery Medical Policy Section Surgery Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date Reviewed with literature search/12/2013 Return to Medical
More informationLaparoscopic Resection Of Colon & Rectal Cancers. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Laparoscopic Resection Of Colon & Rectal Cancers R Sim Centre for Advanced Laparoscopic Surgery, TTSH Feasibility and safety Adequacy - same radical surgery as open op. Efficacy short term benefits and
More informationInnovations in rectal cancer surgery TAMIS and transanal TME
Innovations in rectal cancer surgery TAMIS and transanal TME A.D Hoore MD PhD, EBSQ CR Chair Departement of Abdominal Surgery University Hospitals Leuven, Belgium Actual treatment in rectal Early rectal
More informationIndex. Surg Oncol Clin N Am 14 (2005) Note: Page numbers of article titles are in boldface type.
Surg Oncol Clin N Am 14 (2005) 433 439 Index Note: Page numbers of article titles are in boldface type. A Abdominosacral resection, of recurrent rectal cancer, 202 215 Ablative techniques, image-guided,
More informationCOLON AND RECTAL CANCER
COLON AND RECTAL CANCER Mark Sun, MD Clinical Associate Professor of Surgery University of Minnesota No disclosures Objectives 1) Understand the epidemiology, management, and prognosis of colon and rectal
More informationTransanal Endoscopic Microsurgery (TEM)
Transanal Endoscopic Microsurgery (TEM) Policy Number: 7.01.112 Last Review: 7/2014 Origination: 1/2008 Next Review: 7/2015 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage
More informationCOLON AND RECTAL CANCER
No disclosures COLON AND RECTAL CANCER Mark Sun, MD Clinical Assistant Professor of Surgery University of Minnesota Colon and Rectal Cancer Statistics Overall Incidence 2016 134,490 new cases 8.0% of all
More informationTransanal Endoscopic Microsurgery
Transanal Endoscopic Microsurgery Dana R. Sands, MD, FACS, FASCRS Director, Colorectal Physiology Center Staff Surgeon Department of Colorectal Surgery Cleveland Clinic Florida What is TEM? Minimally invasive
More informationTransanal Excision of Rectal Cancer : What Next?
Transanal Excision of Rectal Cancer : What Next? November 10 th 2017 Meagan Costedio MD FACS FASCRS Medical Director Colorectal Surgery University Hospitals Ahuja Medical Center Associate Professor - Division
More informationLocal Excision of Rectal Cancer Techniques and Outcomes
Local Excision of Rectal Cancer Techniques and Outcomes Manoj J. Raval, MD, MSc, FRCSC Clinical Assistant Professor, UBC Rectal Cancer Update 2008 October 25, 2008 Overview Techniques & Description Patient
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Abdominal surgery prior as factor in laparoscopic colorectal surgery, 554 555 Abscess(es) CRC presenting as, 539 540 Adenocarcinoma of
More information11/21/13 CEA: 1.7 WNL
Case Scenario 1 A 70 year-old white male presented to his primary care physician with a recent history of rectal bleeding. He was referred for imaging and a colonoscopy and was found to have adenocarcinoma.
More informationInnovations in Rectal Cancer Surgery
Innovations in Rectal Cancer Surgery A. D Hoore MD PhD, EBSQ-CR, (hon)fascrs A. Wolthuis MD PhD, EBSQ-CR, FACS G. Bislenghi MD Departement of Abdominal Surgery University Hospitals Leuven, Belgium invasiveness
More informationRectal Cancer. Madhulika G. Varma MD Associate Professor and Chief Section of Colorectal Surgery University of California, San Francisco
Rectal Cancer Madhulika G. Varma MD Associate Professor and Chief Section of Colorectal Surgery University of California, San Francisco Modern Treatment for Rectal Cancer Improve Local Control Improved
More informationMini J.Elnaggar M.D. Radiation Oncology Ochsner Medical Center 9/23/2016. Background
Mini J.Elnaggar M.D. Radiation Oncology Ochsner Medical Center 9/23/2016 Background Mostly adenocarcinoma (scc possible, but treated like anal cancer) 39, 220 cases annually Primary treatment: surgery
More information8. The polyp in the illustration can be described as (circle all that apply) a. Exophytic b. Pedunculated c. Sessile d. Frank
Quiz 1 Overview 1. Beginning with the cecum, which is the correct sequence of colon subsites? a. Cecum, ascending, splenic flexure, transverse, hepatic flexure, descending, sigmoid. b. Cecum, ascending,
More informationFEP Medical Policy Manual
FEP Medical Policy Manual Effective Date: April 15, 2018 Related Policies: None Transanal Endoscopic Microsurgery Description Transanal endoscopic microsurgery (TEMS) is a minimally invasive approach for
More informationNeoadjuvant Therapy for Rectal Cancer is Overrated. Joon H. Lee, Research Resident University of Colorado 8/31/2009
Neoadjuvant Therapy for Rectal Cancer is Overrated Joon H. Lee, Research Resident University of Colorado 8/31/2009 Objectives Brief overview of staging rectal cancer Current guidelines for evaluation and
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Abdominoperineal excision, of rectal cancer, 93 111 current controversies in, 106 109 extent of perineal dissection and removal of pelvic floor,
More informationTransanal Surgery for Large Rectal Polyps and Early Rectal Cancer
Transanal Surgery for Large Rectal Polyps and Early Rectal Cancer AB Harikrishnan Consultant Colorectal Surgeon, Sheffield Honorary Clinical Senior Lecturer, Sheffield University Associate TPD General
More informationCase Conference. Craig Morgenthal Department of Surgery Long Island College Hospital
Case Conference Craig Morgenthal Department of Surgery Long Island College Hospital Neoadjuvant versus Adjuvant Radiation Therapy in Rectal Carcinoma Epidemiology American Cancer Society statistics for
More informationAdjuvant Chemotherapy for Rectal Cancer: Are we making progress?
Adjuvant Chemotherapy for Rectal Cancer: Are we making progress? Hagen Kennecke, MD, MHA, FRCPC Division Of Medical Oncology British Columbia Cancer Agency October 25, 2008 Objectives Review milestones
More informationLarge polyps: EMR, ESD, TEM and segmental resection. Terry Phang 2017 SON fall update
Large polyps: EMR, ESD, TEM and segmental resection Terry Phang 2017 SON fall update Key Points: Large polyps No RCT re: Recurrence, complications Piecemeal vs en bloc: EMR vs ESD Partial vs full-thickness:
More informationA critical review of the role of local excision in the treatment of early (T1 and T2) rectal tumors
Review Article A critical review of the role of local excision in the treatment of early (T1 and T2) rectal tumors Thomas A. Heafner 1, Sean C. Glasgow 2 1 Department of Surgery, San Antonio Military Medical
More informationOutcome of rectal cancer after radiotherapy with a long or short waiting period before surgery, a descriptive clinical study
Original Article Outcome of rectal cancer after radiotherapy with a long or short waiting period before surgery, a descriptive clinical study Elmer E. van Eeghen 1, Frank den Boer 2, Sandra D. Bakker 1,
More informationA Review of Rectal Cancer. Tim Geiger, MD Assistant Professor of Surgery, Colon and Rectal Surgery Vanderbilt University Medical Center
A Review of Rectal Cancer Tim Geiger, MD Assistant Professor of Surgery, Colon and Rectal Surgery Vanderbilt University Medical Center No disclosures Disclosures About me.. Grew up in Southern Illinois
More informationmalignant polyp Daily Challenges in Digestive Endoscopy for Endoscopists and Endoscopy Nurses BSGIE Annual Meeting 18/09/2014 Mechelen
Plan Incidental finding of a malignant polyp 1. What is a polyp malignant? 2. Role of the pathologist and the endoscopist 3. Quantitative and qualitative risk assessment 4. How to decide what to do? Hubert
More informationStructured Follow-Up after Colorectal Cancer Resection: Overrated. R. Taylor Ripley University of Colorado Grand Rounds April 23, 2007
Structured Follow-Up after Colorectal Cancer Resection: Overrated R. Taylor Ripley University of Colorado Grand Rounds April 23, 2007 Guidelines for Colonoscopy Production: Surveillance US Multi-Society
More informationLocal Excision for early rectal cancer
Local Excision for early rectal cancer M. Trompetto, E. Ganio, G. Clerico, A. Realis Luc, RJ Nicholls Colorectal Eporediensis Centre Clinica S. Rita Vercelli Gruppo Policlinico di Monza Mortality Morbidity
More informationPostoperative morbidity and recurrence after local excision of rectal adenomas and rectal cancer by transanal endoscopic microsurgery
Original article Postoperative morbidity and recurrence after local excision of rectal adenomas and rectal cancer by transanal endoscopic microsurgery B. H. Endreseth*, A. Wibe*, M. Svinsås*, R. Mårvik*
More informationPAPER. Review of Results After Endoscopic and Surgical Therapy
Rectal Carcinoid Tumors PAPER Review of Results After Endoscopic and Surgical Therapy Mary R. Kwaan, MD, MPH; Joel E. Goldberg, MD; Ronald Bleday, MD Objective: To assess whether endoscopic treatment can
More informationPathohistological Assessment of the Circular Margin of Resection During Total Mesorectal Excision, Conducted on The Malignant Formations of the Rectum
International Journal of Research Studies in Science, Engineering and Technology Volume 4, Issue 5, 2017, PP 17-22 ISSN : 2349-476X http://dx.doi.org/10.22259/ijrsset.0405004 Pathohistological Assessment
More informationTransanal Endoscopic Microsurgery. Description. Section: Surgery Effective Date: April 15, 2017
Subject: Transanal Endoscopic Microsurgery Page: 1 of 10 Last Review Status/Date: March 2017 Transanal Endoscopic Microsurgery Description Transanal endoscopic microsurgery (TEMS) is a minimally invasive
More informationRectal Cancer: Classic Hits
Rectal Cancer: Classic Hits Charles M. Friel, MD Associate Professor of Surgery Section of Colon and Rectal Surgery University of Virginia September 28, 2016 None Disclosures 1 Objectives Review the Classic
More informationManagement of pt1 polyps. Maria Pellise
Management of pt1 polyps Maria Pellise Early colorectal cancer Malignant polyp Screening programmes SM Invasive adenocar cinoma Advances in diagnostic & therapeutic endoscopy pt1 polyps 0.75 5.6% of large-bowel
More informationRectal Cancer : Curative treatment without surgery
Rectal Cancer : Curative treatment without surgery Dieter Hahnloser dieter.hahnloser@chuv.ch CHUV University Hospital Lausanne Switzerland Reasons for intervention (surgery) Cure Live longer Feel better
More informationPreoperative adjuvant radiotherapy
Preoperative adjuvant radiotherapy Dr John Hay Radiation Oncology Program BC Cancer Agency Vancouver Cancer Centre The key question for the surgeon Do you think that this tumour can be resected with clear
More informationGuidelines for Laparoscopic Resection of Curable Colon and Rectal Cancer
SAGES Society of American Gastrointestinal and Endoscopic Surgeons http://www.sages.org Guidelines for Laparoscopic Resection of Curable Colon and Rectal Cancer Author : SAGES Webmaster PREAMBLE The following
More informationTransanal Endoscopic Microsurgery (TEM)
Transanal Endoscopic Microsurgery (TEM) Policy Number: 7.01.112 Last Review: 7/2017 Origination: 1/2008 Next Review: 7/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage
More informationRole of MRI for Staging Rectal Cancer
Role of MRI for Staging Rectal Cancer High-resolution MRI has supplanted endoscopic ultrasound for staging rectal cancer. High-resolution MR images closely match histology and can show details such as
More informationChemoradiation (CRT) Safety Analysis of ACOSOG Z6041: A Phase II Trial of Neoadjuvant CRT followed by Local Excision in ut2 Rectal Cancer
Chemoradiation (CRT) Safety Analysis of ACOSOG Z6041: A Phase II Trial of Neoadjuvant CRT followed by Local Excision in ut2 Rectal Cancer Emily Chan, Qian Shi, Julio Garcia-Aguilar, Peter Cataldo, Jorge
More informationRECTAL CANCER CLINICAL CASE PRESENTATION
RECTAL CANCER CLINICAL CASE PRESENTATION Francesco Sclafani Medical Oncologist, Clinical Research Fellow The Royal Marsden NHS Foundation Trust, London, UK esmo.org Disclosure I have nothing to declare
More informationTransanal Excision with Radiation Therapy for Rectal Adenocarcinoma
CM&R Rapid Release. Published online ahead of print September 20, 2012 as Original Research Transanal Excision with Radiation Therapy for Rectal Adenocarcinoma Nathan Tennyson, MD; William M. Mendenhall,
More informationCarcinoma del retto: Highlights
Carcinoma del retto: Highlights Stefano Cordio Struttura Complessa di Oncologia Medica ARNAS Garibaldi Catania Roma 17 Febbraio 2018 Disclosures Advisory Committee, research funding and speakers bureau
More informationCorporate Medical Policy Transanal Endoscopic Microsurgery (TEMS)
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: transanal_endoscopic_microsurgery_(tems) 6/2008 11/2018 11/2019 11/2018 Description of Procedure or Service
More informationMedical Policy Transanal Endoscopic Microsurgery
Medical Policy Transanal Endoscopic Microsurgery Subject: Transanal Endoscopic Microsurgery (TEM) Overview: Transanal endoscopic microsurgery (TEM) is a minimally invasive surgical technique developed
More informationName of Policy: Transanal Endoscopic Microsurgery (TEMS)
Name of Policy: Transanal Endoscopic Microsurgery (TEMS) Policy #: 313 Latest Review Date: October 2013 Category: Surgery Policy Grade: B Background/Definitions: As a general rule, benefits are payable
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 4 2013 Article 3 Sigmoidorectal Intussusception Presenting as Prolapse Per Anus in an Adult Venugopal Hg Hasmukh B. Vora Mahendra S. Bhavsar SMT.NHL
More informationCOLORECTAL CARCINOMA
QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF COLORECTAL CARCINOMA Ministry of Health Malaysia Malaysian Society of Colorectal Surgeons Malaysian Society of Gastroenterology & Hepatology Malaysian
More informationNOVA SCOTIA RECTAL CANCER PROJECT: A POPULATION-BASED ASSESSMENT OF RECTAL CANCER CARE AND OUTCOMES. Devon Paula Richardson
NOVA SCOTIA RECTAL CANCER PROJECT: A POPULATION-BASED ASSESSMENT OF RECTAL CANCER CARE AND OUTCOMES by Devon Paula Richardson Submitted in partial fulfilment of the requirements for the degree of Master
More informationRelated Policies None
Medical Policy BCBSA Ref. Policy: 7.01.112 Last Review: 11/15/2018 Effective Date: 11/15/2018 Section: Surgery Related Policies None DISCLAIMER Our medical policies are designed for informational purposes
More informationMUSCLE-INVASIVE AND METASTATIC BLADDER CANCER
MUSCLE-INVASIVE AND METASTATIC BLADDER CANCER (Text update March 2008) A. Stenzl (chairman), N.C. Cowan, M. De Santis, G. Jakse, M. Kuczyk, A.S. Merseburger, M.J. Ribal, A. Sherif, J.A. Witjes Introduction
More informationRadiotherapy for Rectal Cancer. Kevin Palumbo Adelaide Radiotherapy Centre
Radiotherapy for Rectal Cancer Kevin Palumbo Adelaide Radiotherapy Centre Overview CRC are common (3 rd commonest cancer) rectal Ca approx 25-30% of all CRC. Presentation PR bleeding: beware attributing
More informationAdvanced techniques for resection of large polyps. John G. Lee, MD February 2, 2018
Advanced techniques for resection of large polyps John G. Lee, MD February 2, 2018 Background 1cm - large polyp on screening 2cm - large for polypectomy 3cm giant polyp 10-15% of polyps can t be removed
More informationis time consuming and expensive. An intra-operative assessment is not going to be helpful if there is no more tissue that can be taken to improve the
My name is Barry Feig. I am a Professor of Surgical Oncology at The University of Texas MD Anderson Cancer Center in Houston, Texas. I am going to talk to you today about the role for surgery in the treatment
More informationDisclosure. Acknowledgement. What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Rectal cancer imaging. None
What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Zhen Jane Wang, MD Assistant Professor in Residence UC SF Department of Radiology Disclosure None Acknowledgement Hueylan Chern, MD, Department
More informationRadiotherapy for rectal cancer. Karin Haustermans Department of Radiation Oncology
Radiotherapy for rectal cancer Karin Haustermans Department of Radiation Oncology O U T L I N E RT with TME surgery? Neoadjuvant or adjuvant RT? 5 x 5 Gy or long-course CRT? RT with new drugs? Selection
More informationStaging Colorectal Cancer
Staging Colorectal Cancer CT is recommended as the initial staging scan for colorectal cancer to assess local extent of the disease and to look for metastases to the liver and/or lung Further imaging for
More informationPresent Status and Perspectives of Colorectal Cancer in Asia: Colorectal Cancer Working Group Report in 30th Asia-Pacific Cancer Conference
Present Status and Perspectives of Colorectal Cancer in Asia: Colorectal Cancer Working Group Report in 30th Asia-Pacific Cancer Conference Jpn J Clin Oncol 2010;40(Supplement 1)i38 i43 doi:10.1093/jjco/hyq125
More informationRectal Cancer Update 2008 The Last 5 cm. Consensus Building
Rectal Cancer Update 2008 The Last 5 cm Consensus Building Case Distal Rectal Cancer 65 male physician Rectal mass: 5cm from anal verge, 1cm above sphincter? Imaging choice: CT vs MR vs ERUS? Adjuvant
More informationShort course radiation therapy for rectal cancer in the elderly: can radical surgery be avoided?
Short communication Short course radiation therapy for rectal cancer in the elderly: can radical surgery be avoided? Michael A. Cummings 1, Kenneth Y. Usuki 1, Fergal J. Fleming 2, Mohamedtaki A. Tejani
More informationQuality of life after minimally invasive surgery for rectal cancer
Chen et al. Mini-invasive Surg 2018;2:42 DOI: 10.20517/2574-1225.2018.59 Mini-invasive Surgery Review Open Access Quality of life after minimally invasive surgery for rectal cancer Jason H. Chen 1, Jennifer
More informationMinimally Invasive Esophagectomy- Valuable. Jayer Chung, MD University of Colorado Health Sciences Center December 11, 2006
Minimally Invasive Esophagectomy- Valuable Jayer Chung, MD University of Colorado Health Sciences Center December 11, 2006 Overview Esophageal carcinoma What is minimally invasive esophagectomy (MIE)?
More informationLong-term Follow-up of Local Rectal Cancer Surgery by Transanal Endoscopic Microsurgery
World J Surg (2008) 32:1162 1167 DOI 10.1007/s00268-008-9512-1 Long-term Follow-up of Local Rectal Cancer Surgery by Transanal Endoscopic Microsurgery Xavier Serra-Aracil Æ Helena Vallverdú Æ Jordi Bombardó-Junca
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GASTROINTESTINAL RECTAL CANCER GI Site Group Rectal Cancer Authors: Dr. Jennifer Knox, Dr. Mairead McNamara 1. INTRODUCTION 3 2. SCREENING AND
More informationThe effect of rectal washout on local recurrence following rectal cancer surgery
COLORECTAL SURGERY Ann R Coll Surg Engl 208; 00: 46 5 doi 0.308/rcsann.207.0202 The effect of rectal washout on local recurrence following rectal cancer surgery SR Moosvi, K Manley, J Hernon Norfolk and
More informationThe Binational Colorectal Cancer Audit. A/Prof Paul McMurrick Head, Cabrini Monash University Dept of Surgery 2017
The Binational Colorectal Cancer Audit A/Prof Paul McMurrick Head, Cabrini Monash University Dept of Surgery 2017 Binational Colorectal Cancer Database 2010 First Patient 2011 Contract between CMUDS and
More informationRectal cancer management: a team sport The role of radiology and the multidisciplinary conference
Rectal cancer management: a team sport The role of radiology and the multidisciplinary conference W. Donald Buie MD MSc FRCSC Professor of Surgery and Oncology Department of Surgery University of Calgary
More informationWhat are TEMS/TEO/TAMIS and Who should it?
What are TEMS/TEO/TAMIS and Who should it? Neil Borley Consultant Surgeon General Hospital Is more actually less? Neil Borley Consultant Surgeon General Hospital Key questions Does the equipment matter?
More information11/09/2014. Update Management of Rectal Cancer. Outline. I have no disclosures
Update Management of Rectal Cancer June 7, 2014 W. Donald Buie MD,MSc, FRCSC Associate Professor of Surgery University of Calgary I have no disclosures Outline Pre-operative staging Who needs neoadjuvant
More informationThe detection rate of early gastric cancer has been increasing owing to advances in
Focused Issue of This Month Sung Hoon Noh, MD, ph.d Department of Surgery, Yonsei University College of Medicine E - mail : sunghoonn@yuhs.ac J Korean Med Assoc 2010; 53(4): 306-310 Abstract The detection
More informationDiagnostic and management strategies for lateral pelvic lymph nodes in low rectal cancer a review of the evidence
Review Article Diagnostic and management strategies for lateral pelvic lymph nodes in low rectal cancer a review of the evidence Dedrick Kok Hong Chan 1,2, Ker-Kan Tan 1,2, Takashi Akiyoshi 3 1 Division
More informationIMAGING GUIDELINES - COLORECTAL CANCER
IMAGING GUIDELINES - COLORECTAL CANCER DIAGNOSIS The majority of colorectal cancers are diagnosed on colonoscopy, with some being diagnosed on Ba enema, ultrasound or CT. STAGING CT chest, abdomen and
More informationDifferential lymph node retrieval in rectal cancer: associated factors and effect on survival
Original Article Differential lymph node retrieval in rectal cancer: associated factors and effect on survival Cedrek McFadden 1, Brian McKinley 1, Brian Greenwell 2, Kaylee Knuckolls 1, Patrick Culumovic
More informationCurrent innovations in colorectal surgery
Current innovations in colorectal surgery KS Chapple Consultant Colorectal Surgeon Sheffield Teaching Hospitals NHS Trust Do we need more innovations? What innovations are there and are they worthwhile?
More informationPATHOLOGY GROUP GUIDELINES FOR THE EXAMINATION AND REPORTING OF COLORECTAL CANCER SPECIMENS
PATHOLOGY GROUP GUIDELINES FOR THE EXAMINATION AND REPORTING OF COLORECTAL CANCER SPECIMENS Produced by: Address: Yorkshire Cancer Network Pathology Group Arthington House, Cookridge Hospital, Hospital
More informationDelayed anastomotic leakage following laparoscopic intersphincteric resection for lower rectal cancer: report of four cases and literature review
Iwamoto et al. World Journal of Surgical Oncology (2017) 15:143 DOI 10.1186/s12957-017-1208-2 CASE REPORT Open Access Delayed anastomotic leakage following laparoscopic intersphincteric resection for lower
More informationSurgical Management of Advanced Stage Colon Cancer. Nathan Huber, MD 6/11/14
Surgical Management of Advanced Stage Colon Cancer Nathan Huber, MD 6/11/14 Colon Cancer Overview Approximately 50,000 attributable deaths per year Colorectal cancer is the 3 rd most common cause of cancer-related
More informationL impatto dell imaging sulla definizione della strategia terapeutica
GISCoR L impatto dell imaging sulla definizione della strategia terapeutica M. Galeandro U.C. Radioterapia Oncologica ASMN-IRCCS Reggio Emilia 14 Novembre 2014 Rectal Cancer TNM AJCC-7 th edition 2010
More informationMUSCLE - INVASIVE AND METASTATIC BLADDER CANCER
10 MUSCLE - INVASIVE AND METASTATIC BLADDER CANCER Recommendations from the EAU Working Party on Muscle Invasive and Metastatic Bladder Cancer G. Jakse (chairman), F. Algaba, S. Fossa, A. Stenzl, C. Sternberg
More informationDisclosures. Personalized Approaches to Gastrointestinal Cancers. Objectives. What is personalized cancer care. Go through some genomic studies
Personalized Approaches to Gastrointestinal Cancers Emily Groves, MD Colorectal Surgery Assistant Professor, Division of Surgical Oncology Disclosures None Objectives What is personalized medicine and
More informationA superficial radiotherapy B single pass curettage C excision with 2 mm margins D excision with 5 mm margins E Mohs micrographic surgery.
1- A 63-year-old woman presents with a non-healing lesion on her right temple that has been present for over two years. On examination there is a 6 mm well defined lesion with central ulceration, telangiectasia
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Adenocarcinoma, pancreatic ductal, laparoscopic distal pancreatectomy for, 61 Adrenal cortical carcinoma, laparoscopic adrenalectomy for, 114
More informationFinancial Disclosure. Learning Objectives. Review and Impact of the NCDB PUF. Moderator: Sandra Wong, MD, MS, FACS, FASCO
Review and Impact of the NCDB PUF Moderator: Sandra Wong, MD, MS, FACS, FASCO Financial Disclosure I do not have personal financial relationships with any commercial interests Learning Objectives At the
More informationInnovative Surgical Management in the Treatment of Rectal Cancer: MIS, Robotic, and Beyond
Innovative Surgical Management in the Treatment of Rectal Cancer: MIS, Robotic, and Beyond Jonathan E. Efron, MD, FACS, FASCRS The Mark M Ravitch, MD Endowed Professorship in Surgery Chief of the Ravitch
More informationWhen is local excision appropriate for early rectal cancer?
Surg Today (2014) 44:2000 2014 DOI 10.1007/s00595-013-0766-3 REVIEW ARTICLE When is local excision appropriate for early rectal cancer? Kotaro Maeda Yoshikazu Koide Hidetoshi Katsuno Received: 12 July
More informationS. Atallah B. Martin-Perez M. Albert. T. debeche-adams G. Nassif L. Hunter S. Larach
Tech Coloproctol (2014) 18:473 480 DOI 10.1007/s10151-013-1095-7 ORIGINAL ARTICLE Transanal minimally invasive surgery for total mesorectal excision (TAMIS TME): results and experience with the first 20
More informationCitation for published version (APA): Bartels, S. A. L. (2013). Laparoscopic colorectal surgery: beyond the short-term effects
UvA-DARE (Digital Academic Repository) Laparoscopic colorectal surgery: beyond the short-term effects Bartels, S.A.L. Link to publication Citation for published version (APA): Bartels, S. A. L. (2013).
More informationTransanal endoscopic microsurgery: indications and results after 100 cases
Original article Transanal endoscopic microsurgery: indications and results after 100 cases P. Palma*, S. Freudenberg*, S. Samel* and S. Post* *Department of Surgery, University Clinic, Mannheim, Germany
More informationColorectal Pathway Board (Clinical Subgroup): Imaging Guidelines September 2015
Colorectal Pathway Board (Clinical Subgroup): Imaging Guidelines September 2015 1 Contents Page No. 1. Objective 3 2. Imaging Techniques 3 3. Staging of Colorectal Cancer 5 4. Radiological Reporting 6
More informationCOLORECTAL CANCER FAISALGHANISIDDIQUI MBBS; FCPS; PGDIP-BIOETHICS; MCPS-HPE
COLORECTAL CANCER FAISALGHANISIDDIQUI MBBS; FCPS; PGDIP-BIOETHICS; MCPS-HPE PROFESSOR OF SURGERY & DIRECTOR, PROFESSIONAL DEVELOPMENT CENTRE J I N N A H S I N D H M E D I C A L U N I V E R S I T Y faisal.siddiqui@jsmu.edu.pk
More informationColorectal Cancer Care
Colorectal Cancer Care A Cancer Care Map for Patients Understanding the process of care that a patient goes through in the diagnosis and treatment of colorectal cancer in BC. ROUND2.3_CRCa_20pages_5.5x8.5_FINAL.indd
More informationBOWEL CANCER. Causes of bowel cancer
A cancer is an abnormality in an organ that grows without control. The growth is often quite slow, but will continue unabated until it is detected. It can cause symptoms by its presence in the organ or
More informationIncidence and Multiplicities of Adenomatous Polyps in TNM Stage I Colorectal Cancer in Korea
Original Article Journal of the Korean Society of J Korean Soc Coloproctol 2012;28(4):213-218 http://dx.doi.org/10.3393/jksc.2012.28.4.213 pissn 2093-7822 eissn 2093-7830 Incidence and Multiplicities of
More information